TY - JOUR
T1 - Characteristics of children enrolled in medicaid with high-frequency emergency department use
AU - Peltz, Alon
AU - Samuels-Kalow, Margaret E.
AU - Rodean, Jonathan
AU - Hall, Matthew
AU - Alpern, Elizabeth R.
AU - Aronson, Paul L.
AU - Berry, Jay G.
AU - Shaw, Kathy N.
AU - Morse, Rustin B.
AU - Freedman, Stephen B.
AU - Cohen, Eyal
AU - Simon, Harold K.
AU - Shah, Samir S.
AU - Katsogridakis, Yiannis
AU - Neuman, Mark I.
N1 - Funding Information:
fundinG: Dr Peltz acknowledges salary support from the Robert Wood Johnson Foundation. Dr Aronson received support for this work from CTSA grant KL2 TR001862 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. Dr. Freedman is supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. None of the funders were involved in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Funded by the National Institutes of Health (NIH).
PY - 2017/9
Y1 - 2017/9
N2 - BACKGROUND AND OBJECTIVES: Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. METHODS: Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1-16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013- 2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use. RESULTS: A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3-1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1-1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9-2.3]) experienced the highest likelihood for sustaining high ED use. CONCLUSIONS: One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk.
AB - BACKGROUND AND OBJECTIVES: Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. METHODS: Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1-16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013- 2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use. RESULTS: A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3-1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1-1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9-2.3]) experienced the highest likelihood for sustaining high ED use. CONCLUSIONS: One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk.
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U2 - 10.1542/peds.2017-0962
DO - 10.1542/peds.2017-0962
M3 - Article
C2 - 28765381
AN - SCOPUS:85028728488
VL - 140
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 3
M1 - e20170962
ER -